Ready To Learn: Pre-enrollment 2023-2024 Form

Ready To Learn: Pre-enrollment 2023-2024 Form
Please complete this inital form for possible enrollment in the RTL program.

For questions, please contact:

-- Terese Maguire --
-- tmaguire@milforded.org --
Instructional Supervisor/Early Learning
(203) 783-3627

-- Meredith Toth --
-- mtoth@milforded.org --
Admin. Asst./Early Learning
(203) 783-3497
Child's Name*

Child's First Name Child's Last Name
Child's Date of Birth (Child must be 3 years old by January 1, 2024).*

MonthDay Year
Date
Child's Gender*

MaleFemale
Child lives with*

Mother and fatherMotherFatherOther/Guardian
Mother's Information
Mother's Name*

Mother's First Name Mother's Last Name
Mother's Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Mother's email address*
example@example.com
Mother's Phone Number*
Please enter a valid phone number.
Father's Information
Father's Name*

Father's First Name Father's Last Name
Father's Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Father's email address*
example@example.com
Father's Phone Number*
Please enter a valid phone number.
Other/Guardian's Information
Other/Guardian's Name

Other/Guardian's First Name Other/Guardian's Last Name
Other/Guardian's Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Other/Guardian's Email
example@example.com
Other/Guardian's Phone Number
Please enter a valid phone number.
Other Information
Size of Household (All adults and children are counted)*
Home Elementary School*
Gross Family Annual Income (Estimate-income verification will need to be submitted before enrollment)*
My child receives Birth to 3 services*

YesNo
Should be Empty:

Ready To Learn: Pre-enrollment 2023-2024 Form

Mother's Information

Father's Information

Other/Guardian's Information

Other Information